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1.
BMC Health Serv Res ; 21(1): 1081, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635113

RESUMO

BACKGROUND: We investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP. We also studied the contribution of several district-level contextual and mental health service factors to mental disorder DP. METHODS: Subjects were all those granted mental disorder DP for the first time between 2010 and 2015 in Finland (N = 36,879). Associations between the district-level contextual and mental health service factors and regional DP risks collected from the year 2015 were studied with negative binomial regression analysis in the Finnish hospital districts. The population number on the age (18 to 65 years), gender, occupational status and residential hospital district of the Finnish population from 2015 was used as exposure in the model. RESULTS: Significant differences in the regional mental disorder DP risks between and within hospital districts did not appear to follow the traditional Finnish health differences. A lower risk of DP was associated with contextual indicators of higher regional socioeconomic level. Furthermore, population density as a proxy for access to mental health services indicated a higher regional DP risk for lower density in all mental (IRR 1.10; 95% CI 1.06-1.14) and mood disorder (IRR 1.12; 95% CI 1.08-1.16) DP. Both the highest and the lowest regional numbers of all mental health outpatient visits were associated with a higher DP risk in all mental and mood disorder DP, whereas particularly low regional numbers of inpatient treatment periods and of patients were associated with a lower risk of DP. CONCLUSIONS: In this comprehensive population-level study, we found evidence of significant regional variation in mental disorder DP and related district-level factors. This variation may at least partly relate to differences in regional mental health service systems and treatment practices. Adapting to the needs of the local population appears to be indicated for both regional mental health service systems and treatment practices to achieve optimal performance.


Assuntos
Pessoas com Deficiência , Deficiência Intelectual , Serviços de Saúde Mental , Adolescente , Adulto , Idoso , Finlândia/epidemiologia , Humanos , Pessoa de Meia-Idade , Pensões , Adulto Jovem
2.
BMC Public Health ; 21(1): 1847, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641841

RESUMO

BACKGROUND: Work disability is a complex issue that requires preventive efforts from healthcare systems and individuals, and that too often results in disability pensions (DP). While many studies have attempted to characterize risk factors of work disability, many showing for example a link between socioeconomic positions, working conditions and frequent attendance to OH primary care it is not known if frequent attendance is associated with DP despite the sociodemographic factors. This study aims to address this gap and examine the association between frequent attendance to OH primary care and DP, when adjusted by sociodemographic factors. METHODS: This study combines routine medical record data of an occupational health service provider with comprehensive national registers. Medical record data were used to define groups of frequent attenders to OH primary care (FA) (1-year-FA, 2-year-FA, persistent-FA and non-FA) from 2014 to 2016. The sociodemographic factors (including i.e. educational level, occupational class, unemployment periods) were derived from Statistic Finland and DP decisions were derived from Finnish Centre for Pensions. Association of frequent attendance to OH primary care with DP decisions were analyzed and adjusted by sociodemographic factors. RESULTS: In total, 66,381 patients were included. Basic and intermediate education along with manual and lower non-manual work predicted frequent attendance to OH primary care. Unemployment in 2013 did not predict frequent attendance to OH primary care. Frequent attendance to OH primary care was associated with DP within next two years, even when adjusted for sociodemographic factors. The association of frequent attendance to OH primary care with DP grew stronger as high service use persisted over time. CONCLUSIONS: Frequent attendance to OH primary care is associated with DP risk in the near future despite the underlying sociodemographic differences. Patients using OH primary care services extensively should be identified and rehabilitative needs and measures necessary to continue in the work force should be explored. Sociodemographic issues that co-exist should be explored and considered when planning interventions.


Assuntos
Serviços de Saúde do Trabalhador , Saúde do Trabalhador , Finlândia/epidemiologia , Seguimentos , Humanos , Pensões , Atenção Primária à Saúde
3.
Cad Saude Publica ; 37(10): e00084120, 2021.
Artigo em Português | MEDLINE | ID: mdl-34644751

RESUMO

Aging of the Brazilian population with the country's diversity of demographic and territorial characteristics motivated this study on the effects of retirement pensions on health and wellbeing. The study thus analyzes the effects of retirement pensions in Brazil by age and contribution time through measures of overall self-rated health, depressive symptoms on the CES-D scale, and household and head-of-household income. The analyses were also disaggregated by gender and locality. The method used was Propensity Score Matching with data from 9,412 individuals 50 years or older obtained from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected in the years 2015 and 2016. In overall self-rated health, there was an increase in the probability of rating health as good or excellent for women in urban areas, both for those retired by contribution time (more than 9%) and by age (more than 7%). There was a reduction in the probability of depressive symptoms for women that retired by contribution time (11%), while for men from rural areas there was a reduction of more than 16%. There were important increases in income in all the subgroups. The study aimed to help offset the lack of evidence on the effects of retirement pensions in Brazil, and the results generally suggest that the effects of retirement pensions on individuals´ health and wellbeing are beneficial but quite heterogeneous between men and women and between rural and urban areas.


Assuntos
Pensões , Aposentadoria , Brasil , Feminino , Humanos , Renda , Estudos Longitudinais , Masculino
4.
BMC Health Serv Res ; 21(1): 982, 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34537032

RESUMO

BACKGROUND: The guiding principle of disability insurance in Switzerland is 'rehabilitation before pension'. Access to rehabilitation measures to restore, maintain or improve the earning capacity of individuals with disabilities is essential. Gainful employment enables them to be an active part of society, improves their quality of life, and may mitigate the adverse health effects of disability pension receipt. The aim of this study was therefore to identify factors for disability insurance benefit application in Switzerland. METHODS: A novel dataset was created linking the 2010 Social Protection and Labour Market cross-section with administrative register data on disability insurance benefit application (2009-2018). Multiple logistic regression was employed to examine the associations between long-term health-related activity limitation, region of residence, demographic and socioeconomic characteristics and disability insurance benefit application in adults aged 18-55 (N = 18,448). Sensitivity analysis based on age was performed in individuals aged 18 to retirement age and aged 25 to 55. RESULTS: The regression results showed higher odds of disability insurance benefit application for individuals suffering from long-term health-related activity limitations (OR 2.88; 95% CI 1.29-6.44; p-value 0.010); born outside of Switzerland (OR 1.75; 95% CI 1.32-2.32; p-value 0.000); living without a working partner (OR 1.54; 95% CI 1.17-2.02; p-value 0.002); living without a child aged 0-14 years (OR 1.70; 95% CI 1.29-2.26; p-value 0.000); aged 18-39 (OR 1.41; 95% CI 1.09-1.83; p-value 0.009); with a learnt occupation in 'Manufacturing' (OR 2.75; 95% CI 1.68-4.50; p-value 0.000), 'Construction and mining' (OR 2.03; 95% CI 1.13-3.66; p-value 0.018), 'Trade and transport' (OR 2.12; 95% CI 1.30-3.45; p-value 0.003), 'Business and administration' (OR 1.68; 95% CI 1.03-2.72; p-value 0.036), and 'Health, teaching, culture and science' (OR 1.55; 95% CI 1.05-2.29; p-value 0.026); and renters (OR 1.44; 95% CI 1.00-1.94; p-value 0.016). The results were robust to alternative samples defined by age - albeit with some differences in regional and learnt occupational patterns. CONCLUSIONS: The results suggested that disability insurance benefit application is more than a health-related phenomenon in Switzerland. However, the results provided a less consistent picture on the role of marginalization in application than in other European countries.


Assuntos
Pessoas com Deficiência , Seguro por Invalidez , Adulto , Criança , Humanos , Pensões , Qualidade de Vida , Suíça
5.
BMC Musculoskelet Disord ; 22(1): 771, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507585

RESUMO

BACKGROUND: Musculoskeletal pain is a risk factor for leaving the labour market temporarily and permanently. While the presence of multi-site pain increases the risk of disability pension, we lack detailed knowledge about pain intensity as a risk factor. This study investigated the association between musculoskeletal pain intensity in different body regions and risk of future disability pension among eldercare workers. METHODS: Eight thousand seven hundred thirty-one female eldercare workers replied to a questionnaire on work and health in 2005 and were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated hazard ratios (HR) for disability pension from pain intensities (0-9 numeric rating scale (NRS)) in the low-back, neck/shoulders, and knees during the previous 3 months. Analyses were mutually adjusted for pain regions, age, education, lifestyle, psychosocial work factors, and physical exertion at work. RESULTS: During 11-year follow-up, 1035 (11.9%) of the eldercare workers received disability pension. For all body regions among all eldercare workers, dose-response associations were observed between higher pain intensity and risk of disability pension (p < 0.001). The risk for disability pension was increased when reporting "very high" pain levels (≥7 points on the 0-9 NRS) in the low-back (HR 2.19, 95% CI 1.70-2.82), neck/shoulders (HR 2.34, 95% CI 1.88-2.92), and knees (HR 1.89, 95% CI 1.44-2.47). Population attributable risks (PAR) were 15.5, 23.2, and 9.6% for pain > 2 on NRS in the low-back, neck/shoulders, and knees, respectively, indicating that 15.5, 23.2, and 9.6% fewer eldercare workers would likely receive disability pension if the pain intensity was reduced to 2 or less. For workers ≤45 years and > 45 years, PAR was highest for neck/shoulder pain (27.6%) and low-back pain (18.8%), respectively. CONCLUSIONS: The present study found positive dose-response associations between pain intensity in the low-back, neck/shoulders, and knees, and risk of disability pension during 11-year follow-up. Moderate to very high levels of musculoskeletal pain in eldercare workers should, therefore, be considered an early warning sign of involuntary premature exit from the labour market. These findings underscore the importance of preventing, managing, and reducing musculoskeletal pain to ensure a long and healthy working life.


Assuntos
Pessoas com Deficiência , Dor Musculoesquelética , Feminino , Seguimentos , Humanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/epidemiologia , Pensões , Estudos Prospectivos , Fatores de Risco
6.
BMC Public Health ; 21(1): 1687, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530777

RESUMO

BACKGROUND: Earlier studies indicate a correlation between disability claims experience and return to work outcomes. Thus, the insurer's role and actions may affect the self-rated health of the disabled worker and the outcomes of occupational rehabilitation. This study diversifies the existing empirical evidence on the role of the insurer in the rehabilitation process and reveals the critical actions that best promote success. MATERIALS AND METHODS: Explorative factor analysis (EFA) and confirmatory factor analysis (CFA), followed by binary regression, were used to analyse survey data of disabled workers (n = 661) who had undergone an occupational rehabilitation within an earnings-related pension insurance system in Finland. RESULTS: The claimant's perceptions of the insurer's (1) high-quality informing and guidance, (2) customer orientation, (3) smooth process flow and (4) positive service attitude had substantial and statistically significant effects on the success of occupational rehabilitation after adjusting for all likely confounding variables. CONCLUSIONS: The insurer's actions are significant predictors of the outcome of occupational rehabilitation. The insurer can promote the health of rehabilitees most effectively by ensuring a smooth process flow and adopting a customer-oriented approach.


Assuntos
Pessoas com Deficiência , Seguradoras , Estudos Transversais , Humanos , Pensões , Retorno ao Trabalho
7.
Swiss Med Wkly ; 151: w30027, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-34558884

RESUMO

AIMS: In Switzerland, certain patients with disabilities and reduced working ability are entitled to a disability pension granted by the Swiss Federal Social Insurance Office (FSIO). The aim was to assess the evolution of disability pension and work capacity after kidney transplantation and thereby pilot the procedures linking FSIO data with Swiss Transplant Cohort Study (STCS) data. METHODS: The current study pilot tested the record linkage of FSIO data with data from the STCS in a single-centre, observational setting. Patients were requested to consent to the use of their Swiss social security number (SSSN) for the purpose of record linkage. A privacy preserving trust centre approach was implemented with blinded statistical analysis. RESULTS: Between May 2008 and December 2015, 282 working-age renal transplant recipients of the University Hospital of Basel transplant centre were eligible for inclusion and 136 (48%, median age 48 years) consented to the use of their social security number and record linkage. The FSIO datasets of all patients were successfully retrieved and linked to STCS data in the trust centre and were numerically analysable. Yearly FSIO allowance data were available for the entire study duration. Fifty-five patients (40%) were registered as disability insurance recipients (DIR). In the entire population, the proportion of working patients slightly decreased from 76% to 72% between the pre-transplant and the post-transplant period. This was due to the lower proportion of patients working after transplantation in DIR compared with non-recipients (non-DIR) (DIR: 60% before vs 44% after; non-DIR: 83% before vs 88% after). In the DIR group, the proportion of patients not working increased from 36% to 49%, whereas in non-DIR the proportion changed only marginally (14% to 12%). The average disability insurance allowance was CHF 1172 per month. It changed from CHF 1135 before transplantation to CHF 1209 after transplantation (p = 0.59). CONCLUSIONS: In the Swiss healthcare and social insurance system, record linkage studies combining clinical datasets with data from FSIO are feasible but associated with great efforts and resource needs. The lack of changes in disability allowances after kidney transplantation should be further investigated in the nationwide setting.


Assuntos
Pessoas com Deficiência , Seguro por Invalidez , Transplante de Rim , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Pensões , Suíça
8.
Artigo em Inglês | MEDLINE | ID: mdl-34501526

RESUMO

Low back pain (LBP) patients undergoing lumbar spine decompression surgery (LSDS) often suffer from multi-comorbidity and experience high work disability. This study aimed to identify diagnosis-specific work disability patterns in all LBP-patients before and after LSDS during 2008-2010, that were aged 19-60 years and living in Sweden (n = 10,800) and compare these patterns to LBP-patients without LSDS (n = 109,179), and to matched individuals without LBP (n = 472,191). Work disability days (long-term sickness absence (LTSA), disability pension (DP)) during the three years before to three years after the cohort's entry date were identified by generalised estimating equations. LBP-patients undergoing LSDS had higher overall work disability during the three years following surgery (LTSA: 23.6%, DP: 6.3%) than LBP-patients without LSDS (LTSA: 19.5%, DP: 5.9%), and those without LBP (LTSA: 7.9%, DP: 1.7%). Among patients undergoing LSDS, the prevalence of work disability due to dorsopathies increased from 20 days three years before surgery to 70 days in the year after and attenuated to 30 days in the third year following surgery. Work disability for other diagnoses remained stable at a low level in this group (<10 days annually). LBP-patients undergoing LSDS have an unfavourable long-term work disability prognosis, primarily due to dorsopathies. Decompression surgery seemed to restrict further inclines in work disability in the long run.


Assuntos
Pessoas com Deficiência , Licença Médica , Descompressão , Humanos , Pensões , Suécia/epidemiologia
9.
Front Public Health ; 9: 710128, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395373

RESUMO

As China experiences rapid aging, the mental health of older rural adults has become a major public health concern. Among other social insurance programs, the New Rural Social Pension (NRSP) scheme was established to replace part of the income for old-age rural residents in China. This article employs survey data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018 to investigate the impact of a pension on depression in middle-aged and old residents. Our results show that the pension scheme not only reduces the depressive symptoms of the rural residents but keeps down the prevalence rate of depression. Among the subscribers of the pension scheme, the pensioners benefit more from enrolling in the pension scheme than the contributors in terms of depression alleviation. The impact of pension on depression displays heterogeneity; female residents, residents in central China, and/or those from lower income households are found to be positively affected. It is also confirmed that a pension scheme contributes to easing depression via reduced labor supply, better family support, and more consumption expenditure. JEL Classification: H55, I18, I38.


Assuntos
Saúde Mental , Pensões , Adulto , China/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , População Rural
10.
Artigo em Inglês | PAHO-IRIS | ID: phr-54572

RESUMO

[ABSTRACT]. This paper examines inequalities in income security in later age. Three dimensions of inequality are consid-ered: (i) inequalities in access to income support across countries and types of schemes; (ii) inequalities in the level of support within countries; and (iii) trends in gender inequality. Scheme stratification reinforces inequalities across socioeconomic groups and gender. More egalitarian, and sustainable, outcomes in later age income security in Latin America require policy reforms aimed at the incorporation of excluded groups and the withdrawal of public subsidies supporting privileged retirees.


[RESUMEN]. En este documento se examinan las desigualdades entre las personas mayores en cuanto a la seguridad de los ingresos. Se consideran tres dimensiones de la desigualdad: a) las desigualdades en el acceso al apoyo a los ingresos en los diferentes países y los distintos tipos de planes; b) las desigualdades en el nivel de apoyo en cada país; y c) las tendencias de las desigualdades en materia de género. La estratificación de los planes contribuye a incrementar la desigualdades de género y en todos los grupos socioeconómicos. Para obtener resultados más equitativos y sostenibles en cuanto a la seguridad de los ingresos de las personas mayores es necesaria una reforma de las políticas dirigida a la incorporación de los grupos excluidos y la eliminación de las ayudas públicas a los jubilados que gozan de privilegios.


[RESUMO]. Este artigo examina as desigualdades na segurança de renda na terceira idade. Três dimensões da desigual-dade são analisadas: (i) desigualdades no acesso ao auxílio à renda entre os países e esquemas de benefícios, (ii) desigualdades no grau de auxílio em cada país e (iii) tendências da desigualdade de gênero. A estratificação dos esquemas reforça as desigualdades de gênero e entre os níveis socioeconômicos. Resul-tados mais igualitários e sustentáveis na segurança de renda para pessoas da terceira idade na América Latina exigem reformas políticas visando à inclusão dos segmentos atualmente excluídos da população e a eliminação de subsídios públicos para aposentados em situação privilegiada.


Assuntos
Fatores Socioeconômicos , Renda , Pensões , América Latina , Fatores Socioeconômicos , Renda , Pensões , América Latina , Fatores Socioeconômicos , Renda , Pensões , COVID-19
12.
Prev Med ; 150: 106717, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34242665

RESUMO

We investigated the associations between health behaviors and sustainable working life outcomes including all-cause disability pension, disability pensions due to musculoskeletal and mental diagnoses and unemployment. The role of familial factors behind these associations was studied by analysing discordant twin pairs. Our data included Swedish twins born in 1925-1986 (51891 twin individuals). Baseline data based on two independent surveys in 1998-2003 and 2005-2006 for health behaviors were linked to national registers on disability pension and unemployment until 2016. Cox proportional hazards models for hazard ratios (HR) with 95% confidence intervals (CI) were estimated for the whole sample adjusting for covariates. Analyses of health behavior discordant twin pairs (n = 5903 pairs) were conducted using conditional Cox models. In the whole cohort, the combination of healthy behaviors was associated with lower risk for all-cause disability pension, disability pension due to musculoskeletal diagnoses or mental diagnoses, and for unemployment (HRs 0.56-0.86, 95% CIs 0.51-0.92) as did being physically active (HRs 0.69-0.87, 95% CI 0.65-0.92). The discordant pair analyses confirmed the lower risk among those having healthy behaviors (HR 0.70-0.86) or being physically active (HR 0.86-0.87) for all-cause disability pension, disability pension due to musculoskeletal diagnoses, and for unemployment. To conclude, controlling the effects of covariates or familial confounding (i.e. discordant twin pair analyses) shows that being physically active or having several healthy behaviors predict better working life outcomes. This points towards independent association between healthy behavior and longer working life.


Assuntos
Pessoas com Deficiência , Pensões , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas , Exercício Físico , Humanos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fumar , Suécia
13.
Accid Anal Prev ; 159: 106262, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34175780

RESUMO

OBJECTIVE: Knowledge regarding sickness absence (SA) and disability pension (DP) following a road traffic injury, is lacking. The aim of this study was to investigate SA and DP among injured car occupants before and after a crash, accounting for permanent medical impairment (PMI). Further, to explore associations between injured body region, car model year of introduction (MYI), and European New Car Assessment Programme (Euro NCAP) safety rating and number of SA/DP days in year two and four following the crash date. METHODS: A longitudinal cohort study including 63,358 individuals injured when aged 17-62, in crashes occurring 2001-2013 and involving a car insured by the Folksam Insurance Group. Mean numbers of SA/DP net days per year were calculated, in total and by injury diagnosis category, for all, for those with SA or DP with the same diagnosis as the initial injury, and for those with and those without injuries resulting in PMI. Logistic regressions were performed to calculate odds ratios with 95% confidence intervals for having 90-180 or ≥181 combined SA/DP days, respectively, among those with injury diagnoses, in year two and four after the crash. Associations with injured body region, car model introduction year, and Euro NCAP star ratings, was investigated, with adjustments made for sociodemographics. RESULTS: The mean number of SA/DP days/year was higher in the years following the crash (56-50 days) compared to the year prior (41). In year one and two the increase in days was mainly with SA due to injury diagnoses and musculoskeletal diagnoses, and in year three and four, with DP due to injury diagnoses, musculoskeletal diagnoses, and mental diagnoses, respectively. Individuals whose injuries resulted in PMI had more future SA/DP days compared to those without PMI. Individuals with injuries to the torso/back and with multiple injuries were more likely to have > 180 SA/DP days both year two (2.9 and 2.2 times, respectively) and year four (2.0 and 1.6 times), compared to individuals with head injuries. Injured occupants in Euro NCAP 2-3-star rated cars as well as in untested cars, were more likely to have > 180 days in year four (1.4 and 2.0 times, respectively), compared to 4-5 stars. CONCLUSION: Higher levels of SA/DP remained throughout the four years following the crash, with substantial differences between those with PMI and those with no PMI. Low overall car safety level, injuries to the torso/back, and multiple injuries were associated with high SA/DP.


Assuntos
Acidentes de Trânsito , Automóveis , Humanos , Estudos Longitudinais , Pensões , Estudos Prospectivos , Suécia
14.
Expert Rev Pharmacoecon Outcomes Res ; 21(5): 1135-1144, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34165377

RESUMO

BACKGROUND: As healthcare management of highly active-relapsing-remitting multiple sclerosis (HA-RRMS) patients is more complex than for the whole multiple sclerosis (MS) population, this study assessed the related economic burden from a National Health Insurance's (NHI's) perspective. RESEARCH DESIGN AND METHODS: Study based on French NHI databases, using individual data on billing and reimbursement of outpatient and hospital healthcare consumption, paid sick leave and disability pension, over 2010-2017. RESULTS: Of the 9,596 HA-RRMS adult patients, data from 7,960 patients were analyzed with at least 2 years of follow-up. Mean annual cost/patient was €29,813. Drugs represented 40% of the cost, hospital care 33%, disability pensions 9%, and all healthcare professionals' visits combined 8%. Among 3,024 patients under 60 years-old with disability pension, disability pension cost €7,168/patient/year. Among 3,807 patients with paid sick leave, sick leave cost €1,956/patient/year. Mean costs were €2,246/patient higher the first year and increased by €1,444 between 2010 and 2015, with a €5,188 increase in drug-related expenditures and a €634 increase in healthcare professionals' visits expenditures but a €4,529 decrease in hospital care expenditures. CONCLUSIONS: The cost of health care sick leaves, and disability pensions of HA-RRMS patients was about twice as high as previously reported cost of MS patients.


Assuntos
Efeitos Psicossociais da Doença , Hospitalização/estatística & dados numéricos , Esclerose Múltipla Recidivante-Remitente/terapia , Esclerose Múltipla/terapia , Adulto , Estudos de Coortes , Bases de Dados Factuais , Atenção à Saúde/economia , Atenção à Saúde/métodos , Pessoas com Deficiência , Feminino , Seguimentos , França , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/economia , Esclerose Múltipla Recidivante-Remitente/economia , Programas Nacionais de Saúde/economia , Pensões/estatística & dados numéricos , Estudos Retrospectivos , Licença Médica/economia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34071494

RESUMO

Background: A unified or consensus definition of "sustainable working life" remains lacking, although studies investigating risk factors for labour market exit are numerous. In this study, we aimed (1) to update the information and to explore a definition of "sustainable working life" via a systematic literature review and (2) to describe the working life trajectories via the prevalence of sickness absence (SA), disability pension (DP), and unemployment in a Swedish twin cohort to provide a sample overview in our Sustainable Working Life-project. Methods: A systematic literature review was conducted to explore the studies with the search phrase "sustainable working life" in PubMed, PsycInfo, and the Web of Science Database of Social Sciences in January 2021, resulting in a total of 51 references. A qualitative synthesis was performed for the definitions and the measures of "sustainable working life." Based on the Swedish Twin project Of Disability pension and Sickness absence (STODS), the current dataset to address sustainable working life includes 108 280 twin individuals born between 1925 and 1990. Comprehensive register data until 2016 for unemployment, SA and DP were linked to all individuals. Using STODS, we analysed the annual prevalence of SA, DP, and unemployment as working life trajectories over time across education and age groups. Results: The reviewed 16 full articles described several distinct definitions for sustainable working life between 2007 and 2020 from various perspectives, i.e., considering workplaces or employees, the individual, organizational or enterprise level, and the society level. The definition of "sustainable working life" appearing most often was the swAge-model including a broad range of factors, e.g., health, physical/mental/psychosocial work environment, work motivation/satisfaction, and the family situation and leisure activities. Our dataset comprised of 81%-94% of individuals who did not meet SA, DP, or unemployment during the follow-up in 1994-2016, being indicative for "sustainable working life." The annual prevalence across years had a decreasing trend of unemployment over time, whereas the prevalence of SA had more variation, with DP being rather stable. Both unemployment and DP had the highest prevalence among those with a lower level of education, whereas in SA, the differences in prevalence between education levels were minor. Unemployment was highest across the years in the youngest age group (18-27 years), the age group differences for SA were minor, and for DP, the oldest age group (58-65 years) had the highest prevalence. Conclusions: No consensus exists for a "sustainable working life," hence meriting further studies, and we intend to contribute by utilising the STODS database for the Sustainable Working Life project. In the upcoming studies, the existing knowledge of available definitions and frameworks will be utilised. The dataset containing both register data and self-reports enables detailed follow-up for labour market participation for sustainable working life.


Assuntos
Pessoas com Deficiência , Licença Médica , Adolescente , Adulto , Idoso , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Pensões , Suécia/epidemiologia , Desemprego , Adulto Jovem
16.
Rehabilitation (Stuttg) ; 60(5): 330-338, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34187079

RESUMO

PURPOSE: For the German rehabilitation system there are only few representative findings on occupational reintegration after medical rehabilitation. For persons who have undergone rehabilitation on behalf of the German Pension Insurance (GPI) due to a respiratory disease, it is therefore needed to determine (a) what socio-medical risks exist prior to rehabilitation, (b) how well persons were able to participate in working life after rehabilitation, and (c) what conditions determine the work participation. METHODS: The study is conducted on the basis of the GPI's database of rehabilitation statistics. Included were all persons, who completed medical rehabilitation in 2016 with a main discharged diagnosis from chapter J of the ICD-10. The analyses were carried out for the entire group and also in a differentiated manner for the the 2 main diseases bronchial asthma and COPD. Work participation was operationalized both via a monthly status variable until 24 months after rehabilitation and as a rate of all persons who were employed at the 12 and 24 months follow up and in the 3 months before, respectively. To analyze the factors influencing stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS: A total of 19,287 data sets were included in the analysis (bronchial asthma: n=9,108, 47%; COPD: n=6,215, 32%). Patients with respiratory diseases were 53 years old on average, both genders were equally distributed. 14% had no absenteeism, 11 % stated an absence leave 6 months or more in the year prior to rehabilitation. Mental and cardiovascular comorbidity was documented in 39 and 38% of the cases, respectively. Overall, patients with COPD had higher socio-medical risks before rehabilitation than asthma patients. Accordingly, only about half of the COPD patients remained in active employment, while about 80% of the asthma patients succeeded in this. The strongest influencing factors on stable work participation were the time of sick leave as well as income prior to rehabilitation. CONCLUSION: About two thirds of all persons with respiratory diseases are in stable employment after medical rehabilitation in Germany, with large differences between asthma bronchiale and COPD. In particular, the absenteeism as well as the wage before rehabilitation determine this. The analysis provides representative data on occupational reintegration after medical rehabilitation due to a respiratory disease for the first time.


Assuntos
Seguro , Pensões , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Licença Médica
17.
Eur J Pain ; 25(10): 2190-2201, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34189810

RESUMO

BACKGROUND: Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence. METHODS: With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a 5-year period between patients either allocated to an IDT programme or to other/no interventions (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration. RESULTS: IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the 5-year period. Intriguingly, sick leave was higher in IDT patients (563 [552, 573] vs. 478 [466, 490] days), whereas disability pension was higher in controls (152 [144, 160] vs. 169 [161, 178] days). CONCLUSION: Although sickness absence decreased over the study period in both IDT patients and controls, we found no support for IDT decreasing sickness absence more than other/no interventions in chronic pain patients. SIGNIFICANCE: In this large study of chronic pain patients in specialist healthcare, sickness absence is compared over a 5-year period between patients in an interdisciplinary treatment programme and other/no interventions. Sickness absence decreased over the study period in bothgroups; however, there was no support forthat it decreased more with interdisciplinary treatment than alternative interventions.


Assuntos
Dor Crônica , Pessoas com Deficiência , Dor Crônica/epidemiologia , Dor Crônica/terapia , Estudos de Coortes , Humanos , Pensões , Licença Médica , Suécia/epidemiologia
18.
Eur J Health Econ ; 22(9): 1393-1409, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34080076

RESUMO

This paper asks whether marriage decisions of unmarried mature couples are driven by the prospect of financial advantages for the later widowed after one partner has suffered a serious health shock. We hypothesize that, in contrast to traditional marriage models, such health shocks may induce unmarried couples to obtain economic benefits, such as survivors' pensions in particular, through marriage in advance of one partner's death. This question has not yet been studied empirically. Hazard models capturing unobserved effects are applied to longitudinal data of the German Socioeconomic Panel. It turns out that the probability of marriage after male partners' health shocks can increase significantly depending on the amount of expected survivors' pensions for the (likely) surviving female partners. In contrast, an increased probability of marriage after health shocks to women (depending on the expected financial benefits to men) was not found. These findings are supported by various robustness checks. Economic and political implications are discussed and the results are placed in an international context.


Assuntos
Casamento , Motivação , Feminino , Humanos , Masculino , Pensões , Fatores Socioeconômicos , Sobreviventes
19.
Pharmacoeconomics ; 39(7): 835-851, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33970446

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a chronic disease associated with increased healthcare utilisation and productivity losses. OBJECTIVE: The objective of this study was to explore the progression of healthcare costs and productivity losses before and after diagnosis of MS in comparison to that of a population-based matched reference group. METHODS: We conducted a nationwide, Swedish register-based cohort study of working-aged people with MS diagnosed in 2010-12 (n = 1988) and population-based matched references without MS (n = 7981). Nine years of observation spanned from 4 years prior (Y-4) to 4 years (Y+4) after the year of diagnosis (Y0). Differences in annual all-cause healthcare costs (inpatient and specialised outpatient healthcare as well as pharmacy-dispensed prescribed drugs) and costs of productivity loss (days with sickness absence and disability pension) were estimated between the people with MS and references using t tests with 95% confidence intervals. The average excess costs of MS were estimated using generalised estimating equation models. RESULTS: People with multiple sclerosis had higher costs before the diagnosis of MS and also thereafter. The mean differences in healthcare costs and productivity losses between the people with MS and matched references in Y-4 were 216 EUR (95% confidence interval 58-374) and 1540 EUR (95% confidence interval 848-2233), with larger cost excesses observed in later study years. Summarising the 9 study years, people with MS had fivefold higher excess healthcare costs than references, and more than twice as high productivity losses. CONCLUSIONS: Excess healthcare costs and productivity losses occur already before the diagnosis of MS and increase with time. The excess costs findings before diagnosis could suggest that an earlier diagnosis might lead to reduced excess costs of MS over time.


Assuntos
Esclerose Múltipla , Idoso , Estudos de Coortes , Humanos , Esclerose Múltipla/diagnóstico , Pensões , Licença Médica , Suécia
20.
PLoS One ; 16(4): e0250130, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861771

RESUMO

The sustainable development of pension systems has been investigated from a financial perspective worldwide. However, the pension adequacy and its effect on the sustainability of a national pension system are still understudied. Using actual replacement rate and modified living standards replacement rate, this study empirically evaluates whether China's New Rural Pension Scheme (NRPS) grants enough livelihood protection for the rural residents in the Northwestern China. The results show that the NRPS fails to meet the basic needs of the elderly people (i.e., age of sixty years or older) or the middle-aged people (forty-five to fifty-nine years old), while it only provides limited protection for the young people (sixteen to forty-four years old). These findings suggest that the current NRPS benefits are very low in the Northwestern China and policy reforms should be further implemented to improve the sustainable development of the New Rural Pension Scheme.


Assuntos
Financiamento Governamental/estatística & dados numéricos , Pensões/estatística & dados numéricos , Desenvolvimento Sustentável/economia , China , Financiamento Governamental/métodos , Financiamento Governamental/tendências , Programas Governamentais/métodos , Humanos , Estudos Longitudinais , Qualidade de Vida/legislação & jurisprudência , Aposentadoria , População Rural , Fatores Socioeconômicos , Desenvolvimento Sustentável/legislação & jurisprudência , Desenvolvimento Sustentável/tendências
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